“I think you enjoy feeling suicidal”

That’s what my psychiatrist said to me today. He hypothesised that I don’t help myself out of a dark place when I am there because I like being there. This from a man who has probably spent a total of about 10 hours with me in the past year.

I was anxious about meeting with Dr L today. I anticipated that he would suggest new treatment options and this worried me. After feeling so much worse on my current medication (Brintellix), I thought he would push for me to go on something different, or one I’ve had before.

He did none of that. He made no suggestions and offered me nothing. He said I need to continue with the Brintellix and that I haven’t given it a chance. Despite the fact I wake up feeling sick every morning and my moods have become far more volatile, he wants me to keep taking it.

The whole meeting was upsetting for me. Dr L seemed irritated, maybe even angry, with me. The way he spoke to me made me feel criticised, disrespected, and unimportant. Here are some of the incredibly unhelpful things he said:

“You know when you punish yourself, you’re punishing other people too. Do you want to punish your wife?”

“You need to engage with your therapy. It’s not enough to just absorb.”

“When you’re having a crisis, what do you expect us to do about it?”

These were all crap things to say. But the last one was the most infuriating. I actually lost my temper when he asked me that. I’d explained how I felt last week and how I didn’t feel supported by the service. My wife called the ‘crisis team’, who are supposed to offer some kind of help in these situations – but never do. When Dr L asked what I wanted from them, I got angry.

I got angry because he put pressure on me to know what treatment / support I need. In what other field of medicine would a patient be asked this question? If I had cancer, would my specialist be asking me to tell him how to treat it? No. I told him I didn’t know what would help, and he basically said that means his team can’t help me. I was so angry by this point I was almost in tears. I ranted at him for a while about how they are the professionals and I didn’t think it was too much to ask for them to intervene when I don’t feel safe with myself. His response was to say that they provide a safe place (you can read here about why I will never go there) and that it isn’t his fault if I don’t like it.

My consultation went on for almost an hour, and the whole time I was being grilled, criticised and pushed. Dr L found fault after fault. He repeatedly told me I have to help myself, because nothing he offers will benefit me if I don’t want to do what’s healthy. I know this. I have talked about it in therapy for years.

Being told I have to love myself, find compassion for myself, be kind to the parts of myself I hate – none of that changes how I feel. It isn’t possible to just conjure up those feelings. I am not able to suddenly decide that from now on I will love myself. That isn’t how it works. Dr L seemed to have no understanding of this, and so drilled home the message that I am a failure and I can’t be helped. I actually left the hospital feeling like my psychiatrist thinks I don’t deserve help because I don’t want to help myself. That’s a horrible, hopeless way to feel.

I talked all of this through in therapy this afternoon. It didn’t make any of it feel better. I got the impression that J thought I was overreacting, being hyper-critical of Dr L. And she basically agrees with him, she just says these things in a softer way. I told her I am scared that there is no support available when I feel unsafe with myself and that was a big part of why I was so upset. I explained why I didn’t want to go to the ‘Safe Haven’ or the Samaritans, and I got the impression she thought my reasons weren’t good enough. She seems to think it would be easy for me to take myself to these places, or A&E if I felt unsafe. It made me realise she really doesn’t understand how it feels to be swamped by that darkness.

It has been a tough day. I feel drained and my head is buzzing. It’s hard not to feel hopeless, when I am struggling so badly and I’m told I have to fix it for myself. I know it’s possible that I will be able to do that – in time and with a lot of work in therapy – but what about the time in between? I can’t describe how it feels to have to sit with everything I’m holding until then.

That is really shit. What he’s saying about Brintellix is the standard answer about psych meds in general if they’re not working as well as had been hoped: “you need to give it a bit longer” “we just need to find the right medication/ right dose” “you can’t expect drugs to do all the work” etc etc. What’s really going on is that he and most other prescribers have no idea whatsoever what to do when the drugs don’t work as advertised (by the company that’s making a shitload of money from the drugs) and you’re the easiest person to blame.

I also think it is a major failing in the mental health system that people in suicidal crisis are not offered treatment that meets their real needs – it’s too invasive, coercive, adversarial and traumatic when, from my own experience and what I’ve heard other people say, what is really needed is a form of respite where you are treated kindly and respectfully, listened to, “looked after” and given time-out from the overwhelming stress until things have calmed down enough to look at other options. I suspect that the reason this type of service if not part of mental health care is that it’s perceived as too expensive, and also that people might in some way become dependent on it instead of addressing their underlying problems. Personally, I think you can worry about that aspect AFTER the suicidal crisis has passed.

Thanks DV. I know you understand the frustrations around meds. I think here in the UK the medical profession doesn’t view suicide as its problem. And sometimes I genuinely feel that the mental health services are designed for failure – as in, if less people survive, then there are less people to treat. They are so overloaded and under-resourced that it’s almost like they rely on this. Anything expensive; i.e. therapy, respite care and inpatient treatment, is only ever done in a very limited way. Unless you’ve got the money to pay for it, most people won’t ever have access to it. They’ll just keep shovelling drugs into you to keep you quiet.

I’ve encountered the same treatment by psychiatrists. I finally found one who specializes in trauma and is a human being. It took a long time. I found him through the therapist search on http://www.isst-d.org.

Glad you’ve found someone who you trust and who understands your issues. Unfortunately, I have to manage with what I’ve been given – I don’t have the option of switching as I am in the care of the NHS. My health insurance has a treatment limit on mental health conditions which I reached last year, so I have no more funding from them. It’s frustrating.

You must try to find a new doctor, someone who will help guide you through these dark timed.

My Psychiatrist is a master of tough love, he said “I’m going to say this because I’m a callous bastard” as he reminds me of things I don’t really like, things like I have to help myself, and he can’t do it for me. But he tells me these things with a firmness that comes with trust and support.

Your doctor sounds like he does not support you. He does not sound like a good fit. You sound defeated and broken, you need and deserve someone who is going to help you, not berate you.

Oh and by the way, on being suicidal… It’s familiar to you. Happiness is unfamiliar and is by default, terrifying. That doesn’t mean you like being suicidal though, just that there is indeed a certain comfort in familiarity, no matter how painful.

Sounds like you have a great doctor. I’m stuck with this one. Which means I need to work out who I can call on in a crisis, or how to deal with it without his support if it happens again. I can’t even begin on that right now. You’re right about the familiarity, it’s something I’ve recognised in therapy. But there was no point in me trying to explain that to Dr L. He had already made his mind up.